Pharmacy Technician - Prior Authorization (Onsite, Phoenix AZ, Full Time)

About the Role

CVS Health is committed to creating a connected, convenient, and compassionate healthcare experience. Join our team of dedicated professionals focused on simplifying healthcare for individuals, families, and communities.

Key Responsibilities

• Handle prior authorization requests received via phone, fax, or electronic submission, using various computer tools and clinical guidelines to perform research that supports prior authorization decisions.
• Timely complete approvals and denials of prior authorizations, ensuring documentation is accurate and up to date.
• Review denial language to confirm compliance with NCQA requirements.
• Adhere strictly to prior authorization workflows, policies, and procedures throughout the workday.
• Respond to a high volume of inquiry calls from providers, pharmacies, members, and internal partners, providing updates on prior authorization statuses using multiple computer systems.
• Maintain a balance between productivity, quality, and meeting timelines.
• Participate in mandatory training sessions and continuing education activities.
• Attend team and departmental meetings as needed.
• Ensure excellent attendance and punctuality.
• Demonstrate proficiency in drug and diagnosis terminology, medical vocabulary, and navigating multiple software tools for documentation and communication.
• Strong written and verbal communication skills are required.
• Work hours are scheduled between 5:00 a.m. and 7:00 p.m. Arizona (MST) time, with 8-hour shifts; weekend and holiday work, including rotating weekends, is required. Overnight shifts may be offered but are not guaranteed. Employees should be prepared to work extended hours as needed.
• Must have a dedicated secure workspace at home with reliable wired internet connection of minimum 100 Mbps download speed.
• Must possess advanced PC skills including efficient use of keyboard, mouse, and multitasking across screens and applications.

Required Qualifications

• Current, valid National Pharmacy Technician certification and applicable state licensure in good standing, maintained throughout employment.
• Experience as a Pharmacy Technician ranging from none to five or more years.
• Ability to multitask and effectively prioritize work responsibilities.
• Flexibility to adapt to changing business or departmental requirements.
• Strong organizational skills.

Preferred Qualifications

• Background in retail or hospital pharmacy environments.
• Experience processing prior authorizations.
• Claims processing expertise.
• Knowledge of Managed Care, Medicare, and Medicaid operations.
• Proficiency with AS400 system.
• Skillful use of software applications including Microsoft Excel, Word, and Outlook.
• Understanding of pharmacy practices and clinical information interpretation.
• Familiarity with drug dosage forms, strengths, and generic/brand name equivalents.

Educational Requirements

High school diploma or G.E.D. required.

Work Schedule and Compensation

• Full-time role requiring 40 hours per week.
• Shift schedules fall within operational hours of 5:00 a.m. to 7:00 p.m. MST with possible weekend and holiday shifts.
• Base hourly pay ranges approximately from $18.50 to $35.29, depending on experience and other factors.
• Eligible for bonuses, commissions, or short-term incentive programs in addition to base pay.

Additional Information

• Applicants with arrest or conviction records will receive consideration in accordance with applicable laws.
• Comprehensive benefits package available including medical, dental, vision coverage, paid time off, retirement options, and wellness programs.